Discover and read the best of Twitter Threads about #SpineIntervention
Most recents (1)
Situation: You’re covering #Neurorad CT-guided biopsies and this case shows up on your list.
Older patient with recently diagnosed clear cell RCC. Lytic lesion in the upper sacrum seen on CT Abd/pelvis.
How do you approach it? #SpineIntervention
1/6
Older patient with recently diagnosed clear cell RCC. Lytic lesion in the upper sacrum seen on CT Abd/pelvis.
How do you approach it? #SpineIntervention
1/6
Some options:
1. Anterolateral approach along the iliac bone.
👎 Long path, lots of bone to drill through.
2. Drill through the lateral aspect of the sacral arch to pass in between the thecal sac and the S1 nerve root.
😕 Durotomy risk 💦 and potential seeding 🫣
What else?
2/6
1. Anterolateral approach along the iliac bone.
👎 Long path, lots of bone to drill through.
2. Drill through the lateral aspect of the sacral arch to pass in between the thecal sac and the S1 nerve root.
😕 Durotomy risk 💦 and potential seeding 🫣
What else?
2/6
Using an 18-Ga as an introducer, you can FNA the lesion with a 22-Ga needle. But the S1 nerve root could still be an issue and there’s not a straight approach through the foramen.
But, we have two tricks up our sleeve that make this possible…
3/6
But, we have two tricks up our sleeve that make this possible…
3/6
